RT Journal Article
SR Electronic
T1 Treatment practice of vasospasm during endovascular thrombectomy: an international survey
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 490
OP 496
DO 10.1136/svn-2023-002788
VO 9
IS 5
A1 Jesser, Jessica
A1 Nguyen, Thanh
A1 Dmytriw, Adam A
A1 Yamagami, Hiroshi
A1 Miao, Zhongrong
A1 Sommer, Louisa Johanna
A1 Stockero, Andrea
A1 Pfaff, Johannes Alex Rolf
A1 Ospel, Johanna
A1 Goyal, Mayank
A1 Patel, Aman B
A1 Pereira, Vitor Mendes
A1 Hanning, Uta
A1 Meyer, Lukas
A1 van Zwam, Wim H
A1 Bendszus, Martin
A1 Wiesmann, Martin
A1 Möhlenbruch, Markus
A1 Weyland, Charlotte Sabine
YR 2024
UL http://svn.bmj.com/content/9/5/490.abstract
AB Background and aim The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT.Methods We conducted an anonymous international online survey (4 April 2023 to 15 May 2023) addressing treatment standards of neurointerventionalists (NIs) practising EVT. Several illustrative cases of patients with vasospasm during EVT were shown. Two study groups were compared according to the NI’s opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis.Results In total, 534 NI from 56 countries responded, of whom 51.5% had performed >200 EVT. Vasospasm was considered a complication potentially influencing the patient’s outcome by 52.6% (group 1) whereas 47.4% did not (group 2). Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely (43.7% vs 33.9%, p=0.033) and more often treated severe large-vessel vasospasm with vasodilators (75.3% vs 55.9%; p<0.001), as well as extracranial vasospasm (61.4% vs 36.5%, p<0.001) and intracranial medium-vessel vasospasm (27.1% vs 11.2%, p<0.001), compared with group 2. In case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT, the study groups showed different treatment strategies. Group 2 continued the EVT immediately more often, without initiating therapy to treat the vasospasm first (9.6% vs 21.1%, p<0.001).Conclusion There is disagreement among NIs about the clinical relevance of vasospasm during EVT and its management. There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.Data are available on reasonable request.